Sex Differences in Externalizing and Internalizing Symptoms of Children with ASD.

The team looked at boys and girls with autism who have average IQ. They wanted to know if one sex shows more outward behavior problems or inward mood problems.

Parents filled out two checklists about their child’s actions and feelings. The study then compared the scores girl-by-girl and boy-by-boy.

Both sexes scored above the typical range on both checklists. Yet the girls’ numbers and the boys’ numbers landed in the same high zone.

In plain words: among autistic kids without intellectual disability, sex does not predict who will be more anxious, sad, hyper, or defiant.

Eussen et al. (2016) saw the opposite. They found early-teen girls with autism reported more depression than boys. The key gap is age: the 2016 kids were 12–15, while C et al. studied younger elementary children. Puberty, not sex alone, may flip the mood gap.

Germani et al. (2014) tracked the same age group for a year and also found no sex difference in core autism traits. Their null result foreshadows this one, giving the picture more weight.

Sutton et al. (2022) dug into single test items and did see girls score higher on “fear/nervousness.” Item-level nuance can hide inside a total score, so keep watching for shy or worried cues even when the overall form looks equal.

You can drop the assumption that girls are automatically the “quieter” or “less troubled” caseload. Screen both sexes for anxiety, irritability, and rule-breaking right from intake. When the child reaches middle school, run the mood check again—puberty may rewrite the risk chart.